570 Use of Non-Insulin Antihyperglycaemic Agents With Cardiovascular Benefit in Australia

Abstract

Majority of type 2 diabetes mellitus (T2DM) patients are treated with non-insulin antihyperglycaemic agents (NIAHA). Recent diabetic guidelines recommend prescription of NIAHA with demonstrated cardiovascular benefits (NIAHA-CV), e.g. SGLT2 inhibitors and select GLP-1 agonists compared to non-insulin antihypgerclyaemic agents with no cardiovascular benefit (NIAHA-NCV). The gap between real-world practice and contemporary guidelines is unknown. We aim to describe prescribing patterns of NIAHA in Australia in 2019. In this study, we reviewed the available statistical data collected by the pharmaceutical benefits scheme (PBS) from the 1st Jan 2019 to 31st Dec 2019 for the number of scripts filled under the PBS/Repatriation schedule of pharmaceutical benefits using the item codes for non-insulin antihyperglycaemic agents. In 2019, metformin was the most commonly prescribed agent (6,282,295). The most popular second line non-insulin agent were the Dipeptidyl peptidase-4 (DPP4) inhibitors (3,425,863) followed by SGLT2 (229,498), Sulfonylureas (1,534,025), GLP1 (798,476), Pioglitazones (57,033) then Acarbose (29,574). Of the GLP1, Dulaglutide was prescribed 259,270 and Exenatide 539,206. Second line NIAHA-CV (SGLT2 inhibitors and Dulaglutide) comprised 31% (2,553,768) of total non-insulin prescriptions. If metformin is excluded as presumed first-line agent, the ratio of OHA-CV to OHA-NCV was 0.46:1 Despite contemporary guidelines, OHA-CVs comprise of a minority of anti-diabetic drug prescriptions, either as likely first-line or second-line agents. Further clinician education is needed to optimize anti-diabetic prescription patterns.